Background: Intertrochanteric fractures are
composed of different anatomic patterns that vary in their degree
of stability following open reduction and internal fixation. A particularly
unstable group is classified as AO/OTA 31-A3, with the
fracture pattern described as reverse oblique or transverse. The
purpose of this study was to compare the results of intramedullary
fixation with those of plate fixation for these intertrochanteric fractures
in elderly patients.
Methods: Thirty-nine elderly patients with AO/OTA
31-A3 intertrochanteric fractures of the femur were randomized into
two treatment groups and were followed for a minimum of one year.
The nineteen patients in Group I were treated with a 95Â° fixed-angle
screw-plate (Dynamic Condylar Screw), and the twenty patients in
Group II were treated with an intramedullary nail (Proximal Femoral
Nail). The treatment groups were comparable with regard to all demographic
and injury variables.
Results: Patients treated with an intramedullary
nail had shorter operative times, fewer blood transfusions, and
shorter hospital stays compared with those treated with a 95Â° screw-plate. Implant
failure and/or nonunion was noted in seven of the nineteen
patients who had been treated with the 95Â° screw-plate. Only one
of the twenty fractures that had been treated with an intramedullary
nail did not heal.
Conclusion: The results of our study support the
use of an intramedullary nail rather than a 95Â° screw-plate for
the fixation of reverse oblique and transverse intertrochanteric
fractures in elderly patients.